International Journal for Equity in Health | |
Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities | |
Peter S Hill1  Claire E Brolan1  Josifini T Baba1  | |
[1] School of Population Health, Faculty of Medicine and Biomedical Science, The University of Queensland, Queensland, Australia | |
关键词: Australia; Mental health; Fear; Healthcare-seeking behaviour; Community controlled health services; Aboriginal; Indigenous; Discrimination; | |
Others : 1137643 DOI : 10.1186/1475-9276-13-56 |
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received in 2014-03-12, accepted in 2014-05-26, 发布年份 2014 | |
【 摘 要 】
Background
Aboriginal and Torres Strait Islanders persistently experience a significantly lower standard of health in comparison to non-Indigenous Australians. The factors contributing to this disparity are complex and entrenched in a history of social inequality, disempowerment, poverty, dispossession and discrimination. Aboriginal medical services (AMS) provide a culturally appropriate alternative to mainstream medical services as a means to address this health disparity and also advocate for Indigenous rights and empowerment. This study provides a vignette of lay perspectives of Aboriginal and Torres Strait Islanders accessing community and government controlled AMS in Brisbane, Queensland with the intention of identifying self-perceived health determinants to inform the post-2015 international development goals.
Methods
Focus group discussions and semi-structured interviews were held with clients of a government-controlled AMS and an Aboriginal community controlled health service (ACCHS) in order to identify their self-identified essential health needs. Conversations were audio recorded, transcribed verbatim and de-identified for analysis. Common themes were identified to highlight important issues around community health needs, how they can be addressed and what lessons can be extended to inform the post-2015 development goals.
Findings and discussion
Participants acknowledge the complexity of health determinants faced by their peoples. Thematic analysis highlighted the pervasive influence of racism through many perceived health determinants; resulting in reduced healthcare seeking behaviour, unhealthy lifestyles and mental health issues. Participants emphasised the marked health improvements seen due to the establishment of Aboriginal medical services in their communities and the importance of the AMS’ role in addressing the negative effects of discrimination on Indigenous health.
Conclusion
It is concluded from this study that AMS are crucial in addressing the negative impacts of continued discrimination on Indigenous health by providing comprehensive, culturally appropriate, community empowering health services. Such services improve Indigenous healthcare seeking rates, provide invaluable health education services and address mental health concerns in communities and must be supported in order to address health inequalities in Australia. Community driven and culturally informed health services should be encouraged globally to address health disparities.
【 授权许可】
2014 Baba et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20150317115833318.pdf | 264KB | download |
【 参考文献 】
- [1]Durey A, Thompson SC: Reducing the health disparities of Indigenous Australians: time to change focus. BMC Health Serv Res 2012, 12:151. BioMed Central Full Text
- [2]Rasmussen M, Guo X, Wang Y, Lohmueller KE, Rasmussen S, Albrechtsen A, Skotte L, Lindgreen S, Metspalu M, Jombart T, Kivisild T, Zhai W, Eriksson A, Manica A, Orlando L, Vega FMDL, Tridico S, Metspalu E, Nielsen K, Ávila-Arcos MC, Moreno-Mayar JV, Muller C, Dortch J, Gilbert MTP, Lund O, Wesolowska A, Karmin M, Weinert LA, Wang B, Li J, et al.: An Aboriginal Australian Genome Reveals Separate Human Dispersals into Asia. Science 2011, 334:94-98.
- [3]Rigby W, Duffy E, Manners J, Latham H, Lyons L, Crawford L, Eldridge R: “Closing the Gap”: Cultural Safety in Indigenous Health Education. Contemp Nurse J Aust Nurs Prof 2010, 37:21.
- [4]4704.0 - The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, Oct 2010. Chapter - Life Expectancy [http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter218Oct+2010 webcite]
- [5]4704.0 - The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, Oct 2010. Chapter - Mortality [http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4704.0Chapter811Oct%202010 webcite]
- [6]Vos T, Barker B, Begg S, Stanley L, Lopez AD: Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. Int J Epidemiol 2009, 38:470-477.
- [7]Summary of Australian Indigenous health, 2012 [http://www.healthinfonet.ecu.edu.au/health-facts/summary webcite]
- [8]Littlefield L, Dudgeon P: AUSTRALIA’S FIRST PEOPLE: Their Social and Emotional Well-being. UN Chron 2010, 47:39-41.
- [9]Walter M: Chapter 5: Aboriginality, Poverty and health - Exploring the Connections. In Bandaids Explor Underlyind Soc Determinants Aborig Health. Edited by Anderson I, Baum F, Bentley M. Casuarina, N.T: Cooperative Research Centre for Aboriginal Health; 2007. [Papers from the Social Determinants of Aboriginal Health Workshop, Adelaide, July 2004]
- [10]Bell S, Boughton B, Bartlett B: Chapter 3: Education as a Determinant of Indigenous Health. In Bandaids Explor Underlying Soc Determinants Aborig Health. Edited by Anderson I, Baum F, Bentley M. Casuarina, N.T: Cooperative Research Centre for Aboriginal Health; 2007. [Papers from the Social Determinants of Aboriginal Health Workshop, Adelaide, July 2004]
- [11]Ring IT, Brown N: Indigenous health: chronically inadequate responses to damning statistics. Med J Aust 2002, 177:629-632.
- [12]Council of Australian Governments Reform Council: Education in Australia 2012: Five Years of Performance. Sydney, NSW: COAG Reform Council; 2013.
- [13]Zhao Y, You J, Wright J, Guthridge SL, Lee AH: Health inequity in the Northern Territory, Australia. Int J Equity Health 2013, 12:79. BioMed Central Full Text
- [14]O’Sullivan D: Justice, culture and the political determinants of indigenous Australian health. Ethnicities 2012, 12:687-705.
- [15]Department of Foreign Affairs and Trade, Australian Government: Achieving the Millenium Development Goals. Canberra, ACT: Australia’s Support 2000–2010; 2010.
- [16]Go4Health: Realizing the Right the Health for Everyone. Copenhagen: The Health Goal for Humanity; 2013.
- [17]Stephens C, Porter J, Nettleton C, Willis R: Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide. The Lancet 2006, 367:2019-2028.
- [18]Australian Medical Association: Public Report Card 2002 - Aboriginal and Torres Strait Islander Health – “No More Excuses. Canberra, ACT: Australian Medical Association; 2002. [Public Report Card - Aboriginal and Torres Strait Islander Health]; 2012.
- [19]Anderson I, Crengle S, Kamaka ML, Tai-Ho C, Palafox N, Jackson-Pulver L: Indigenous Health 1: Indigenous health in Australia, New Zealand, and the Pacific. The Lancet 2006, 367:1775-1785.
- [20]Vickery J, Faulkhead S, Adams K, Clarke A: Chapter 2: Indigenous Insights into Oral History, Social Determinants and Decolonisation. In Bandaids Explor Underlyind Soc Determinants Aborig Health. Edited by Anderson I, Baum F, Bentley M. Casuarina, N.T: Cooperative Research Centre for Aboriginal Health; 2007. [Papers from the Social Determinants of Aboriginal Health Workshop, Adelaide; 2004.
- [21]Donovan V: The Reality of a Dark History; From Contact and Conflict to Cultural Recognition. Arts Queensland: Brisbane, QLD; 2004.
- [22]Rowley CD: Destruction of Aboriginal Society. Canberra, ACT: Australian National University Press; 1970.
- [23]Grant M, Wronski I, Murray RB: Aboriginal Health and History. In Aborig Prim Health Care. 3rd edition. Edited by Couzos S, Murray R. Melbourne: Oxford University Press; 2008.
- [24]National Inquiry into the Separation of Aboriginal, and Torres Strait Islander Children from Their Families In National Inquiry into the Separation of Aboriginal: Bringing Them Home. Text. Sydney, NSW: Human Rights and Equal Opportunity Commission; 1997.
- [25]Parliament of Queensland: Industrial and Reformatory Schools Act 1865. 1865, 2213-2220.
- [26]From Dispossession to Reconciliation [http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp9899/99Rp27 webcite]
- [27]Buckley P, Marley J, Robinson J, Turnbull D: Australia. The Lancet 1998, 351:1569-1578.
- [28]Kingsley J, Townsend M, Henderson-Wilson C, Bolam B: Developing an Exploratory Framework Linking Australian Aboriginal Peoples’ Connection to Country and Concepts of Wellbeing. Int J Environ Res Public Health 2013, 10:678-698.
- [29]Stephens C, Parkes MW, Chang H: Indigenous Perspectives on Ecosystem Sustainability and Health. Ecohealth 2007, 4:369-370.
- [30]Fleming ML, Parker E: Health Promotion: Principles and Practice in the Australian Context. 3rd edition. Crow’s Nest, NSW: Allen & Unwin; 2007.
- [31]Thompson SJ, Gifford SM: Trying to keep a balance: the meaning of health and diabetes in an urban Aboriginal community. Soc Sci Med 2000, 51:1457-1472.
- [32]Ypinazar VA, Margolis SA, Haswell-Elkins M, Tsey K, Valmae A: Indigenous Australians’ understandings regarding mental health and disorders. Aust N Z J Psychiatry 2007, 41:467-478.
- [33]Shahid S, Bleam R, Bessarab D, Thompson SC: “If you don’t believe it, it won’t help you”: use of bush medicine in treating cancer among Aboriginal people in Western Australia. J Ethnobiol Ethnomed 2010, 6:18. BioMed Central Full Text
- [34]Maynard J: Circles in the Sand: An Indigenous Framework of Historical Practice. Aust J Indig Educ 2007, 36(Supplementary):117.
- [35]McDermott R, O’Dea K, Rowley K, Knight S, Burgess P: Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines. Aust N Z J Public Health 1998, 22:653-658.
- [36]Vickery J, Clarke A, Karen M: Ngang-gak to Koories Kila about Degaia (Listen Up to Koories Speak about Health). Aborig Isl Health Work J 2004, 28:5.
- [37]Thompson SJ, Gifford SM, Thorpe L: The social and cultural context of risk and prevention: food and physical activity in an urban Aboriginal community. Health Educ Behav Off Publ Soc Public Health Educ 2000, 27:725-743.
- [38]Bell K, Couzos S, Daniels J, Hunter P, Mayers N, Murray R: Aboriginal community controlled health services. Gen Pract Aust 2000, 2000:74-103.
- [39]Taylor J, Dollard J, Weetra C, Wilkinson D: Contemporary management issues for Aboriginal Community Controlled Health Services. Aust Health Rev 2001, 24:125-132.
- [40]Constitution of the World Health Organization Am J Public Health Nations Health 1946, 36:1315-1323.
- [41]Thomson N: Australian Aboriginal health and health-care. Soc Sci Med 1984, 18:939-948.
- [42]Bartlett B, Boffa J: The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy. Aust J Prim Health 2005, 11:53-61.
- [43]Australian Medical Association: AMA Aboriginal and Torres Strait Islander Health Audit Report 2012: Progress to Date and Challenges that Remain. Barton, ACT: Australian Medical Association; 2012. Retrieved from https://ama.com.au/node/7809 webcite
- [44]Holland C: Close the Gap - Progress and priorities report 2014. Text. Close the Gap Campaign Steering Committee for Indigenous Health Equality 2014.
- [45]Adams M: Close the Gap: Aboriginal community controlled health services. MJA 2009, 190:593.
- [46]Catford J: Health Promotion: Origins, Obstacles and Opportunities. In Underst Health Determinants Approach. Edited by Keleher H, Murphy B. Melbourne: Oxford University Press; 2004:134-151.
- [47]McDonald H: East Kimberley Concepts of Health and Illness: A Contribution to Intercultural Health Programs in Northern Australia. Aust Aborig Stud 2006, 2:90.
- [48]Grant M, Laird S, Cox M: Fifteen Years of Health Promotion in Kimberley Aboriginal Community-controlled health Services. Health Promot J Austr 1998, 8:46-50.
- [49]Australian Institute of Health and Welfare (AIHW): Measuring the Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander Peoples. Canberra: ACT; 2009.
- [50]Kelly K, Dudgeon P, Gee G, Glaskin B: Living on the edge: social and emotional wellbeing risk and protective factors for serious psychological distress among Aboriginal and Torres Strait Islander people. Text. Casuarina, N.T: Cooperative Research Centre for Aboriginal Health; 2010. [Aboriginal Health]
- [51]Carey TA: A qualitative study of a social and emotional well-being service for a remote Indigenous Australian community: implications for access, effectiveness, and sustainability. BMC Health Serv Res 2013, 13:80. BioMed Central Full Text
- [52]Larson A, Gillies M, Howard PJ, Coffin J: “It”s enough to make you sick’: the impact of racism on the health of Aboriginal Australians. Aust N Z J Public Health 2007, 31:322-329.
- [53]Eades SJ: Reconciliation, social equity and Indigenous health. Med J Aust 2000, 10:468-469.
- [54]Durey A, Thompson SC, Wood M: Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Intern Med J 2012, 42:17-22.
- [55]Treloar C, Gray R, Brener L, Jackson C, Saunders V, Johnson P, Harris M, Butow P, Newman C: “I can’t do this, it’s too much”: building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers. Int J Public Health 2013, 59(2):1-7.
- [56]Van Herk K, Smith D, Andrew C: Identity Matters: Aboriginal Mothers’ Experiences of Accessing Health Care. Contemp Nurse J Aust Nurs Prof 2010, 37:57-68.
- [57]McGrath P, Patton MA: Indigenous understanding of hospice and palliative care: findings from an Australian study. J Hosp Palliat Nurse 2007, 9:189-197.
- [58]Calma T: Chalmers Oration-What’s needed to Close the Gap. Rural Remote Health 2010, 10:1586.
- [59]Van Holst Pellekaan SM: Toward health and wellbeing for indigenous Australians. Postgrad Med J 2005, 81:618-624.
- [60]Yotti” Kingsley J, Townsend M, Phillips R, Aldous D: “If the land is healthy … it makes the people healthy”: The relationship between caring for Country and health for the Yorta Yorta Nation, Boonwurrung and Bangerang Tribes. Health Place 2009, 15:291-299.
- [61]Chu C, Simpson R (Eds): Ecological Public Health: From Vision to Practice. Nathan, Queensland: Institute of Applied Environmental Research, Griffith University; 1994.
- [62]Tynan M, Atkinson P, Bourke L, Atkinson V: Chapter 1: “If You Don”t Have Health, What’s the Use of Living?’ Koori Voices from the Goulburn–Murray Rivers Region on Health and its Determinants. In Bandaids Explor Underlying Soc Determinants Aborig Health. Casuarina, N.T: Cooperative Research Centre for Aboriginal Health; 2007.
- [63]Angus S, Lea T: Planning for better health outcomes requires Indigenous perspective. Aust N Z J Public Health 1998, 22:636-637.
- [64]Thompson SL, Chenhall RD, Brimblecombe JK: Indigenous perspectives on active living in remote Australia: a qualitative exploration of the socio-cultural link between health, the environment and economics. BMC Public Health 2013, 13:473. BioMed Central Full Text
- [65]Morgan DL, Slade MD, Morgan CMA: Aboriginal philosophy and its impact on health care outcomes. Aust N Z J Public Health 1997, 21:597-601.
- [66]Bond CJ: A culture of ill health: public health or Aboriginality? Med J Aust 2005, 183:39-41. [Dr Ross Ingram Memorial Essay: The First of Three Finalists’ Essays]
- [67]Cox L: Fear, trust and Aborigines: The historical experience of state institutions and current encounters in the health system. Health Hist 2007, 9:70-92.
- [68]McGrath P: “The biggest worry…”: reserach findings on pain management for Aboriginal peoples in Northern Territory, Australia. Rural Remote Health 2006, 6:549.
- [69]Towle A, Godolphin W, Alexander T: Doctor–patient communications in the Aboriginal community: Towards the development of educational programs. Patient Educ Couns 2006, 62:340-346.
- [70]Elders K, Newman J, Acklin F, Trindall A, Arbon V, Brock K, Bermingham M, Thompson C: Story-Telling: Australian Indigenous Women’s Means of Health Promotion. Aborig Isl Health Work J 1999, 23:18-21.